Erectile Dysfunction

No sniggering, not even at the back.  This is a serious topic and it was hard to write.

Erectile dysfunction in simple terms is an inability to get your gentleman sausage hard, or if you can, you lose it rather quickly.

More accurately, erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection.

It is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.

I am most grateful to the NHS websites where most of this comes from, do please click right-click and open in new tab the links, and always remember it is best to see your doctor for advice, and, if you do suffer, please remember that around 95% of time something can be done about this  issue.

When to see your GP

See your doctor if you have erectile dysfunction for more than a few weeks. They will assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease (when the heart’s blood supply is blocked or interrupted).

Why does erectile dysfunction happen?

Erectile dysfunction can have a range of causes, both physical and psychological. Physical causes include:

Psychological causes of ED include:

This bit is important:

Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection, but you are unable to get an erection with your sexual partner.

If this is the case, it is likely the underlying cause of erectile dysfunction is psychological (stress related).  If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical.

Erectile dysfunction can also be a side-effect of using certain medicines.

What is an Erection

When a man becomes sexually excited (aroused), his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden.

Anything that interferes with the nervous system or the blood circulation could lead to erectile dysfunction.

Anything that affects the level of sexual desire (libido) can also cause erectile dysfunction because a reduced libido makes it more difficult for the brain to trigger an erection. Psychological conditions, such as depression, can reduce libido, as can changes in hormone levels (chemicals produced by the body).

Physical causes

There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are:

Vasculogenic conditions

Examples of vasculogenic conditions that cause erectile dysfunction include:

  • cardiovascular disease– a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries)
  • high blood pressure(hypertension)
  • diabetes– a condition caused by high blood sugar levels. This can affect both the blood supply and the nerve endings in your penis, so it is also a neurogenic condition

Erectile dysfunction is strongly associated with cardiovascular disease. For this reason, it may be one of the first causes your GP considers when making a diagnosis and planning your treatment.

Neurogenic conditions (Brain, nerves, spinal cord)

Examples of neurogenic conditions that cause erectile dysfunction include:

  • multiple sclerosis– a condition that affects the body’s actions, such as movement and balance
  • Parkinson’s disease– a condition that affects the way that the brain coordinates body movements, including walking, talking and writing
  • a spinal injury or disorder
  • stroke– a serious condition that occurs when the blood supply to the brain is interrupted

Hormonal conditions

Examples of hormonal conditions that cause erectile dysfunction include:

  • hypogonadism – a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels
  • an overactive thyroid gland(hyperthyroidism) – where too much thyroid hormone is produced
  • an underactive thyroid gland(hypothyroidism) – where not enough thyroid hormone is produced
  • Cushing’s syndrome– a condition that affects the production of a hormone called cortisol

Anatomical conditions

Peyronie’s disease, which affects the tissue of the penis, is an example of an anatomical condition that can cause erectile dysfunction.

Certain Medicines can cause ED

In some men, certain medicines can cause erectile dysfunction, including:

  • diuretics – these increase the production of urine and are often used to treat high blood pressure (hypertension), heart failure and kidney disease
  • antihypertensives – such as beta-blockers, that are used to treat high blood pressure
  • fibrates – medicines used to lower cholesterollevels
  • antipsychotics – used to treat some mental health conditions, such as schizophrenia
  • antidepressants– used to treat depression and some types of pain
  • corticosteroids– medication that contains steroids, which are a type of hormone
  • H2-antagonists – medicines used to treat stomach ulcers
  • anticonvulsants – used to treat epilepsy
  • antihistamines– used to treat allergic health conditions, such as hay fever
  • anti-androgens – medication that suppresses androgens (male sex hormones)
  • cytotoxics – medication used in chemotherapyto prevent cancer cells from dividing and growing

Speak to your doctor if you are concerned that a prescribed medicine is causing erectile dysfunction.  Alternative medication may be available. However, it is important never to stop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care.

Psychological causes

Possible psychological causes of erectile dysfunction include:

  • depression– feelings of extreme sadness that last for a long time
  • anxiety – a feeling of unease, such as worry or fear

Erectile dysfunction can often have both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead to an episode of erectile dysfunction.

There are many emotional issues that may also affect your physical ability to get or maintain an erection. These include:

  • relationship problems
  • lack of sexual knowledge
  • past sexual problems
  • past sexual abuse
  • being in a new relationship

Other causes – Take note you lot:

Other possible causes of erectile dysfunction include:

  • excessive alcohol intake
  • tiredness
  • using illegal drugs, such as cannabis, heroin or cocaine

Cycling

Men who cycle for more than three hours per week may be recommended to try a period without cycling to see if this helps improve erectile dysfunction.

Riding in the correct position with a properly fitted seat may also help to prevent regular cycling from leading to erectile dysfunction.

Treating erectile dysfunction

If you have erectile dysfunction (ED), treatment will depend on what’s causing it. The various treatments for erectile dysfunction are outlined below.

Treating underlying conditions

If your erectile dysfunction is caused by an underlying health condition, such as heart disease or diabetes, that condition may need to be treated first. In some cases, treating the underlying cause may also resolve the problem.

Lifestyle changes

Erectile dysfunction can often be improved by making changes to your lifestyle, such as:

As well as helping to improve your erectile dysfunction, these changes can also improve your general health and may help to reduce your risk of cardiovascular disease (conditions that affect your heart and blood vessels).

Phosphodiesterase-5 (PDE-5) inhibitors (The Viagra bit)

Phosphodiesterase-5 (PDE-5) inhibitors are one of the most widely used and effective types of medication for treating erectile dysfunction. They work by temporarily increasing the blood flow to your penis.

In England, four PDE-5 inhibitors are available for treating erectile dysfunction. They are:

  • Sildenafil – sold under the brand name Viagra
  • Tadalafil – sold under the brand name Cialis
  • Vardenafil – sold under the brand name Levitra
  • Avanafil – sold under the brand name Spedra

Sildenafil, vardenafil and avanafil work for about eight hours and they are designed to work ‘on demand’. Tadalafil lasts for up to 36 hours and is more suitable if you require treatment for a longer period of time, for example, over a weekend.

Depending on the type of PDE-5 inhibitor you are taking and the dose, it should take about 30-60 minutes before it starts to work. With sildenafil, vardenafil and avanafil, you should be able to have sex from one to 10 hours after taking the medicine. After taking tadalafil, the effects will last for up to 36 hours.

It may take longer to notice the effects if the tablet is taken with food, so it’s best to take it on an empty stomach. You can then eat after an hour without affecting the medicine.

Only take one tablet within a 24-hour period.

Your GP should explain the benefits of each medication and how it works.

If you do not find that PDE-5 inhibitors are effective it may be because:

  • you have not waited long enough after taking the dose
  • you have waited too long after taking the dose
  • the dose is not high enough
  • you have not had enough sexual stimulation

These medications are triggered by sexual stimulation, so you also need to be aroused for it to work.  Do not take one and expect a miracle to happen!

Do please consult your doctor.  You can also pop into a pharmacy (Sainsbury’s often have them), fill in a form, the pharmacists will check the form, then you can buy direct, but expensive at £36 for 4, so better to go via the doctor, you may even get them free.  I have never tried, but never obtain from the spam e-mails we all get.
 

© Phil the test manager 2019
 

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